Musician Injuries often happen because playing your instrument, whether it is the violin, piano, cello, guitar, flute, drums or even the glockenspiel, is REPETITIVE and ASYMMETRICAL.

Often times, changes in technique, practice habits, instrument set-up, posture, and other life changes can contribute to injury. You may want to examine whether there have been any changes lately and whether they were introduced quickly versus gradually.

Here we have a novice violinist demonstrating six postural habits that can contribute to hand, arm, neck and back pain.

1. Arm Position
A good violin teacher will notice when your hand or wrist is not in an optimal position. However, when playing for a long time, sometimes very subtle changes in position can occur in the forearm, wrist or finger positioning in either the bow or string hands. Repetitive use of a muscle or joint when it is in a non-optimal or neutral position can lead to overuse and eventual repetitive strain injury. A Musician Injury Scan help to identify these variations in posture and prevent injury.

2. Neck and Jaw (TMJ) is Bent to the Left
Here we see the neck is bent to the left. Now, a good music teacher would be fairly quick to correct this posture by bringing the head to as straight as a position as possible. However, it is unavoidable as a violinist to not use the left neck and temporomandibular joint (or jaw) muscles more than the right. A right side bend stretch is one thing a violinist can do to alleviate this left neck and jaw muscle overuse. If you missed our exercise tip sheet from the last post, look here.

3. Right Shoulder Girdle Slump
Pain in the right shoulder, neck and upper back is not uncommon amongst violinists as well. Often times the shoulder blade, or scapula, can be slumped and pulled up and forward from overuse of the upper trapezius and pectoral muscles, and weakness of the lower scapular muscles.

4. Lazy Back
Below we see a loss of the spine’s natural curves. There is an increase in kyphosis, or forward curve, throughout the back. In the low back, we see a loss of lumbar lordosis, or backward curve, along with a pelvis that is tilted back. Playing with these postures in a prolonged fashion contributes to muscles and ligaments being stretched in the back, leading to weakness and eventual pain with overuse in this non-optimal posture.

5. Swayback
Here we see in standing another common posture. The head is forward, the upper thoracic spine is slightly back, the pelvis is pushed forward, the hips are extended and the knees want to lock into hyperextension. All sorts of potential problems here from the spine down to the knees.

6.Non-Violin Related Postures

Another thing to consider is what your posture is like the rest of the day, when you are not playing violin. Below is a common posture we see with our smartphones and devices. This posture, when held prolonged, can contribute to headaches, neck pain, back pain, and arm pain and even numbness and pins and needles.

If you would like to find out how to improve your playing postures as a musician, please keep reading and learning. If you are in the Vancouver area and would like to learn how to deal with your injury in person, click here to make a physiotherapy consultation with Grace:

This video is a great illustration of how playing music engages practically every aspect of the brain. Whereas listening to music results in certain parts of the brain being activated, playing music is like a full body workout to the brain. It engages the visual, auditory and motor parts of the brain and increases the size and activity in the corpus callosum.

ii) Try to keep your speech around the pitch where you naturally say ‘Umm-hmm’; this can be assumed to be your most comfortable speaking pitch and the range in which injury is least likely.

iii) Avoid starting your speech with a glottal attack: going from zero vocalization to a forceful expulsion of air and sound. Instead, begin releasing air before initializing voicing, thinking of it as easing in to sound production.

5. PRACTICE GOOD BREATHING HABITS

i) Practice silent, deep breathing, allowing the air to expand and contract the lower torso, abdomen, back and sides. This encourages relaxation in the throat and less risk of injury.

ii) In daily speech, try to take breaths at natural breaks (it can be hard on the vocal folds to squeeze the breath out beyond what feels natural).

iii) See a vocal professional to learn proper breathing techniques for singing and vocal projection, as improper technique can do damage to your vocal folds!

6. BODY ALIGNMENT, TENSION and FITNESS

Figure 4

i) While singing or speaking, be attuned to your overall body balance and signs of muscle tension in the neck and shoulders. Hint: try videotaping yourself singing/speaking to assess improper balance and tension.

Posture assessment by a physiotherapist can also be very helpful if you think this may be an issue for you. If you are singing or speaking while seated, use a comfortable chair suited to your build, with good lower back support.

ii) Music, scripts or notes should be at eye-level (and on a stand, if possible), and it’s best to have clear sight-lines to your accompanist and audience.

iv) Improving singing posture is showing correlations with improved vocal production! A case study of a classical singing student who underwent physical therapy for breath support and lack of stability. In nine physiotherapy sessions over four months, the patient experienced significant improvement and satisfaction with her resulting vocal production. [It should be noted that this patient was very well motivated to make postural changes and follow her physiotherapist’s recommendations. (Staes, 2011)]

v) A healthy body promotes a healthy voice! Regular exercise, good nutrition, regular eye and ear check-ups, and times of relaxation are going to support extended use of the vocal instrument. Note that obese singers face poor respiratory and abdominal conditioning, a limiting factor in a discipline that relies on strength and stamina.

As with many things in life, awareness is half the battle; hopefully these tips can help you highlight areas in which your vocal hygiene can improve! If you find you have more questions or need further help in applying good vocal habits, please feel free to give us a call at 604-568-4628 and book in to see physiotherapist and musician injury specialist, Grace Cheung.

‘Hygiene’ is a term reminiscent of habits and prevention and health. It is not a far stretch then, that vocal hygiene is a term used to refer to habitual behaviors for preventing injury and promoting vocal health! The following practices are especially important to singers and professionals who depend on good vocal health on a daily basis.

1. HYDRATION is very important to overall body function, and makes a significant difference to vocal fold operation. Adequate water intake allows the mucus covering of the vocal folds to act like a lubricant, rather than like glue; this creates more efficient vocalization. Eight cups (two quarts) of water is the recommended daily intake. In additional, herbal teas have also been suggested to soothe the vocal folds, with some additional hydration.

2. WARMUPS and COOL-DOWNS are going to help prevent vocal strain and injury. It’s important to remember that in many ways, vocalists (both singers and speakers) are like athletes; the muscles of the body are being used repeatedly, and can be prone to injury when overused or abused.

Figure 3

Vocal warmups get blood flowing to the vocal folds, and gently stretch and contract the vocal folds in preparation for extensive use. Physical warmups also are beneficial to loosen the muscles of the neck, shoulders and upper back. Examples are: humming, vocal ‘fry,’ shoulder shrugs, and gentle neck stretches.

Cool-downs have been suggested so as to ease vocal muscles into cessation, rather than an abrupt stop. An example of this is gentle vocal slides up and down the vocal range.

It may be interesting to note that recent research on Vocal Exercises is showing:

–> Vocal exercises may mitigate age-related effects on singing (Tay, 2012). This preliminary study had a group of aging choral singers undergo 5 weeks of daily vocal exercises (warmups, stretching, contracting, strengthening) partially supervised by a Speech-Language Pathologist. Preliminary and post-trial testing showed improvements across several technical measures* as well as perceived improvements in self-evaluation, when compared to the control group.

–> Specific muscle training can make it feel easier and more comfortable to sing, as well as produce sounds with more efficiency and superior quality across several variables. Ideally, there should be some muscle action in the back, head and neck while singing, while the chest, abdomen, and throat should be relaxed – a combination that may require specific muscle training to achieve. **

3. AVOID STRESSING YOUR VOCAL FOLDS:

i) Avoid clearing the throat or coughing (causing extra friction and putting additional stress on the vocal folds). Typically, thick mucus is the culprit behind throat-clearing and coughing. Adequate hydration is key to keeping the mucus at a good consistency, and decreasing throat-clearing and coughing!

Good alternatives to throat-clearing are:

-> The Sniff- Swallow Technique to clear mucus in the throat: sniff gently… swallow, and repeat as needed. (Clark, SLP)

-> The Gentle Breathy Productive Cough: take a deep breath, hold for a moment, and then produce a sharp, silent H sound as you expel the air and mucus. (Texas Voice Centre)

ii) Avoid speaking at vocal extremes: both shouting and whispering put stress to the vocal folds! Try to avoid noisy, windy and cold environments where you need to strain your voice to be heard, attempt to speak within 3 feet of your conversational partner, use amplification when necessary, and use a lowered quieted tone without whispering.

iii) Avoid polluted air and air with less than 30% humidity, as both can make vocalization more effortful (note that airplanes have especially dry air, and the vocal folds will require even more hydration)

Stay tuned The 6 Top Tips for Vocal Hygiene – Part 2to find out more tips for vocal use!

_______________________________________________________________________________Contributor: Tracy Schaan is studying at McGill University in the Masters of Speech-Language Pathology program.

**[Study on “Voicecraft” training has shown that simply telling singers to ‘relax’ while singing is a misdirection; there are correlations between specific muscle use and perceived exertion (some muscles relaxing, while increasing exertion of others). Optimum vocal production is found with muscle action in the back, head and neck, with less muscle exertion in the chest, abdomen, and throat. Results showed that Voicecraft Training:

Made it feel easier and more comfortable to sing: singers rated higher levels of comfort and ease of singing after training of using certain muscles.

Noticeably improves singing quality: 100% of the time judges (Speech-Language Pathologists and Singers) could differentiate between audio recordings before and after training, and 80% of post-training recordings were judged as superior across several variables (roughness, breathiness etc).

Vocal quality was more efficient as measured by the noise-to-harmonic ratio and jitter and shimmer, which had all significantly decreased post-training (Bagnall, 2005)]

“The Effect of Vocal Function Exercises on the Voices of Aging Community Choral Singers.” Journal of Voice, Volume 26 (5). Figure 3. Self portrait by Sebastiaan ter Burg made for his presentations about his business model for Creative Commons photography and video production and his open content/data projects. For more information: www.sebastiaanterburg.nl; from Image Creator Sebastiaan ter Burg; Meezingen/zingen/zang/singing along/sing; flickr; flickr; Aug 31, 2007; Web: http://www.flickr.com/photos/ter-burg/8127279660/in/photostream/; Accessed March 24, 2014.

The notes I handle no better than many pianists. But the pauses between the notes – ah, that is where the art resides!

-Artur Schnabel (Austrian pianist)

The pause is as important as the note.

-Truman Fisher (American composer)

The more I grow as a musician, the more I have come to understand that the pauses and spaces in a composition are equally important as the notes played. As a young musician in an ensemble or group improvisation setting, the temptation for me was to play all the time, often to exercise my zeal in a recently new found skill or technique. But how much more there is to the musical experience when one stops to listen to not just the individual parts but to the piece as a whole, including the spaces and pauses in between.

Which leads me to this. The pause.

What are you doing your pauses when performing and practising?

You are likely listening to the music or perhaps counting measures.

Here are a few other tips I encourage the musical athletes I work with to practise:

Reset your posture: Find that neutral position again where your head and shoulders are sitting on top of your pelvis, with equal weight exerting through both legs or both sides of your buttocks when sitting

Deep breaths: Take a deep, slow belly breath (diaphragmatic breathing). This helps you relax any nervous tension that may have developed when playing.

Shoulder rolls: No matter what instrument played, most musicians will carry some sort of tension in their shoulders. A simple way to reset the muscles is to roll the shoulders forward and backwards a few times during your break.

These few practises will help to prevent unnecessary tension in the muscles. This will benefit you by decreasing your chances of injury; easing your tension when playing, both from the physical and mental aspect.

The student – musician’s body undergoes much asymmetrical stress with repetitive motions during practice and rehearsals, as well as prolonged static postures in sitting, usually at a desk and computer.

Musicians are often compared to athletes. You push your body for hours at a time to practice and perfect your skills so that you can perform better. But sometimes, your bodies become overused, and playing becomes painful. The terms below are often associate d with the performance of elite athletes. But did you know that these same
issues aﬀect the performance of a musician as well?

P O S T U R E
ALIGNMENT
CORE STRENGTH
FLEXIBILITY
REPETITIVE STRAIN

PLAYING WITH PAIN doesn’t always happen right away. Sometimes it starts with “fatigue” or “tension” that eventually goes away. But as time passes, you may ﬁnd that these symptoms linger for a little
longer and don’t go away as easily as they used to. So you take a long break from your instrument and the pain goes away.

Musician Injuries often happen because playing your instrument, whether it is the violin, piano, cello, guitar, ﬂute, drums or even the glockenspiel is REPETITIVE and ASYMMETRICAL.

REPETITIVE
Muscles and tendons need time to recover and rebuild after use. Without adequate rest, their ﬁbres will break down and inﬂammation and pain occur. We call this tendonitis. It ﬁrst starts with fatigue or an ache, and eventually turns into pain and swelling with any type of use, leading to loss of ability to play.

ASYMMETRICAL
Asymmetry combined with repetition is the perfect environment for an injury to brew. It may not appear immediately, but at some point down the road, an injury is likely to occur.

BUT I PLAY ALL THE TIME. WHY DOES IT HURT NOW ?
Often times, changes in technique, practice habits, instrument set-up, posture, and other life changes can contribute to injury. You may want to examine whether there have been any changes lately and whether they were introduced quickly versus gradually.

MY MUSCLES ARE WARM TO TOUCH, REALLY TIGHT, AND THEY HURT WHEN I PLAY. WHAT CAN I DO?

Warmth, pain, and loss of function are signs of inﬂammation. Use the acronym “R.I.C.E”. Rest, Ice, Compress, Elevate.REST from the aggravating activity.ICE on the area for 15 minutes at a time.COMPRESS with a tensor sleeve or brace.ELEVATE the area for 15 minutes at time if it is swollen
Then, consult your physiotherapist to help you get to the
root of the problem to prevent the injury form recurring.

Many injuries I see amongst the novice to intermediate violinist are quite easily preventable. Watch this video for a few practical tips to include when you are next playing your violin. Many of these principles apply to the high performing violinist as well as other instrumentalists too!

There are SO many things to think about when playing, and these are just a few to prevent neck and back pain when playing violin.